CDC/ATSDR Tribal Advisory Committee (TAC) Executive Summary February 14–15, 2017 

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CDC/ATSDR Tribal Advisory Committee Meeting

February 14–15, 2017—Executive Summary

The Centers for Disease Control and Prevention (CDC) and the Agency for Toxic Substances and Disease 

Registry (ATSDR) hosted the Tribal Advisory Committee (TAC) Meeting and 16th Biannual Tribal 

Consultation Session, February 14–15, 2017, at CDC’s Roybal Campus, in Atlanta. During the course of 

the two-day meeting, TAC members held discussions with CDC and ATSDR representatives. 

Topics discussed during the TAC meeting included CDC’s budget, tribal strategies for connecting cultural 

practices in competitive funding opportunities, tribal priorities for the National Center for Injury Prevention 

and Control (NCIPC) and National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), 

tribal capacity in emergency preparedness and response, and tribal public health workforce in surveillance 

and epidemiological data. 

Tuesday, February 14, 2017

Tribal Advisory Committee Business

This session focused on a short list of business items for the committee’s review and discussion. The 

committee reviewed proposed dates for the Summer 2017 TAC and Winter 2018 meetings. The 

committee voted, by quorum, to hold the Summer 2017 TAC meeting August 8–9 in Oklahoma (with 

the city yet to be determined), and the following Winter 2018 TAC on February 6–7, 2018 in Atlanta.

A Tribal Support Unit (TSU) representative highlighted TSU activities provided and a written 

summary of the agency’s 2016 tribal activities. The representative discussed committee recruitment 

activities and requested TAC assistance in filling the two existing vacancies. The session was 

concluded and the meeting was adjourned to Tribal caucus for the remainder of the day.

Wednesday, February 15, 2017

CDC Office of the Director Updates

Rear Admiral Anne Schuchat, Acting Director, CDC, and Acting Administrator, ATSDR, provided

updates from CDC’s Office of the Director. Councilman Antone, TAC Chairman and Tucson Area 

Delegate, presented Rear Admiral Schuchat with a letter from the CDC/ATSDR TAC members. The 

letter reaffirmed the priorities expressed in the October 2016 engagement with the former director, 

Dr. Tom Frieden, and expressed the committee’s strong desire to strengthen the government-togovernment relationship between the agency and tribes. 

Roundtable Discussion with Senior Leaders: Tribal Engagement in Budget Planning and 

Tribal Direct Funding Strategies

The roundtable discussion on budget planning began with senior leaders briefly introducing 

themselves and the work of their centers to the advisory committee. Principal Chief Patrick 

Lambert, Nashville Area Delegate, explained how tribes view federal funding and how CDC can 

better support tribes. He stated that CDC’s budget expenditure in Indian Country is 

disproportionate to the population size and health disparities. He proposed that 2% of CDC’s budget 

should be allocated to serve tribal populations. He concluded that the ideal is to fund tribes 
CDC/ATSDR Tribal Advisory Committee (TAC) Executive Summary February 14–15, 2017

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CDC/ATSDR Tribal Advisory Committee Meeting

February 14–15, 2017—Executive Summary

equitably and to regard CDC’s mission as shared with tribes. Other tribal leaders also shared 

concerns with the senior leaders. These included the following issues: 

• Unequitable distribution of funding to tribes when compare to funding of states for the 

same purposes

• Failure of funding to follow Native American health disparities and disease burden data 

Rear Admiral Schuchat assured tribal leaders that CDC will take the tribes’ budget concerns 

seriously. Senior leaders presented shared funding strategies ideas and suggestions, including the 

following: 

• Differentiation of funding allocations in new opportunity announcements through explicit

statement that certain dollar amounts will be awarded to states, other amounts to locals, 

and still other amounts to tribes

• Inclusion of tracking requirements in funding opportunities restricted to states, so that the 

agency can improve accountability and reporting back to tribes 

Councilman Antone concluded the session with an acknowledgement that CDC is moving in the 

right direction to improve funding for tribes. 

Roundtable Discussion with Senior Leaders: Tribal Strategies for Connecting Cultural 

Practices to Evidence-Based Interventions to Promote Tribal Practices in Competitive 

Funding Opportunities 

Ms. Ileen Sylvester, Alaska Area Authorized Representative, introduced the discussion by stating 

that healthcare for AI/ANs should focus on spiritual, physical, and mental dimensions of health. She 

requested that CDC partner with Indian Country to align AI/AN cultural practices with evidencebased interventions. Dr. Debra Houry, National Center for Injury Prevention and Control (NCIPC)

director, discussed protective factors as a critical component of evidenced-based intervention 

strategies in tribal communities. She suggested that Native programs that promote resiliency could 

greatly benefit both Native and non-Native communities. NCIPC would appreciate the opportunity 

to evaluate and promote the programs that show demonstrated evidence of success as models of 

prevention.

Ms. Sylvester asserted that every funding opportunity should value cultural wisdom in addressing 

public health issues. She recommended that an evaluation by a cultural evaluation specialist be 

standard practice when CDC funds a project in Indian Country. In addition, Ms. Sylvester requested

that funding opportunities have longer project periods, beyond five years, with a non-compete 

clause for long-term sustainability. President Lawrence “Jace” Killsback, Billings Area Delegate, 

suggested that each center should have a tribal liaison to coordinate communication and should 

create tribal specific grants to limit competition. In closing, Ms. Sylvester recommended that the 
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CDC/ATSDR Tribal Advisory Committee Meeting

February 14–15, 2017—Executive Summary

agency create equitable scoring for culturally appropriate practices within funding opportunity 

announcements.

Roundtable Discussion with Senior Leaders: Tribal Priorities for the National Center for 

Injury Prevention and Control 

Dr. Houry introduced the large cross-sectional panel. The TAC provided each panelist with the 

committee’s NCIPC briefing document. The panelists collaborated to respond to the questions in 

the document. 

Captain Holly Billie, injury prevention specialist for the Transportation and Safety Team in NCIPC’s 

Division of Unintentional Injury Prevention, discussed the center’s current work in motor vehicle 

injury prevention in Indian Country. She shared that outcomes from the prior tribal motor vehicle 

safety work were successfully integrated into a best practices guide by CDC and other collaborating 

agencies. Indian Country had directly requested the guide, which was released in November 2016. 

The Transportation and Safety Team’s focus will now shift toward evaluating the adoption and 

implementation of the guidance across Indian Country. 

Dr. Houry reported that NCIPC is currently funding three tribal epidemiology centers (TECs) to 

provide violent death and injury reporting across many domains, including but not limited to opioid 

overdose, traumatic brain injury, and suicide. Dr. Houry shared that the state of Alaska had released 

its National Violent Death report with specific reporting on its AI/AN population. Dr. Houry also 

announced that the center has released its guidelines for prescribing opioids and that the Indian 

Health Service (IHS) had modified the guidance for its prescriber base. She relayed that there is 

ongoing effort to identify and expand direct funding opportunities around opioid abuse prevention 

in Indian Country. 

Ms. Reshma Mahendra, deputy chief of the Health Systems and Trauma Branch in NCIPC’s Division 

of Unintentional Injury, shared that the center is currently identifying barriers preventing tribes 

from entering into the state prescription drug monitoring programs and is determining which steps 

are required to address and remove these barriers. Captain Billie reported that one barrier has been 

that federal providers at IHS facilities are not required to register as providers in the state. Without 

state registration, the providers cannot access the monitoring systems. In response to the NCIPC 

update, TAC delegates shared areas of additional interest and made further recommendations. 

After hearing that NCIPC is funding three TECs, President Killsback asked the center to consider 

funding all TECs. Ms. Lisa Pivec, Authorized Representative for Oklahoma Area, cautioned the 

agency to be aware that not all TECs are the same and that, due to this variability, the agency 

should not only fund TECs. Funding opportunities should be available to the centers, to individual 

tribes, and to other tribal-serving organizations to generate the greatest opportunity for success in 
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CDC/ATSDR Tribal Advisory Committee Meeting

February 14–15, 2017—Executive Summary

Indian Country. Mr. Byron Larson, Tribes-At-Large Delegate, championed the strategy of a multiagency approach to combat areas of concern in public health. NCIPC concluded the session by 

thanking the TAC for including the center in its agenda and for the opportunity to partner with the 

Tribal Advisory Committee. 

Tribal Priorities for the National Center for Chronic Disease Prevention and Health 

Promotion 

Dr. Ursula Bauer, NCCDPHP director, and Captain David Espey, coordinator for CDC’s Good Health 

and Wellness in Indian Country grant program, participated in the roundtable discussion session on 

NCCDPHP priorities. The TAC provided both participants with the committee’s NCCDPHP briefing 

document. Dr. Bauer and Captain Espey collaborated to respond to the document’s questions.

Dr. Bauer started by providing a brief history of NCCDPHP activities, engagements, and investments 

in Indian Country. She then turned her attention to the briefing document. She stated her support 

of funding tribes directly, as well as reaching additional tribes through consortia, tribal serving 

organizations, and TECs. Dr. Bauer asked for additional input on a potential Tribal liaison position,

which was requested for her center in the committee’s briefing document. A Tribal center liaison 

would serve in a variety of outward and inward facing roles. For example, the position could serve

as a direct liaison to TSU for NCCDPHP. In addition, each Tribal liaison officer would work with his or 

her center to build capacity in Indian country and could serve as a project officer to Tribal grantees. 

Addressing another suggestion by the committee, Dr. Bauer advised that CDC cannot create a field 

office but that the Department of Health and Human Services does have this authority. Responding 

to a recommendation about improving tribal access to data, Dr. Bauer stated that her center 

spearheads the data linkages project to ensure that AI/AN data is complete. She committed to 

working harder to ensure that there is access to database resources. Dr. Bauer asked for guidance 

from the committee about social media and marketing for Native Americans. Ms. Pivec expressed 

her hope that the agency would continue to develop culturally relevant outreach efforts in 

collaboration with Indian Country. As the session came to a close, Mr. Larson acknowledged the 

need for capacity building in Indian country and thanked Dr. Bauer for NCCDPHP’s efforts. 

Tribal Public Health Capacity in Emergency Preparedness and Response

Mr. Gregory Smith, tribal liaison officer in the Office of Public Health Preparedness and Response’s 

(OPHPR’s) Division of State and Local Readiness, participated in the roundtable discussion session 

on Tribal Public Health Capacity in Emergency Preparedness and Response. The TAC provided Mr. 

Smith with the committee’s OPHPR briefing document.

Mr. Smith provided a brief overview of the Public Health Emergency Preparedness cooperative 

agreement awarded to states and sub-awarded by states to tribes. He also reported that the office 

has strongly encouraged states to include tribes in the past, but that the new cooperative 

agreement language further strengthens this by strengthens this by requiring routine reporting on 
CDC/ATSDR Tribal Advisory Committee (TAC) Executive Summary February 14–15, 2017

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CDC/ATSDR Tribal Advisory Committee Meeting

February 14–15, 2017—Executive Summary

on engagement efforts and outcomes. Principle Chief Lambert, acknowledged the Pandemic and 

All-Hazards Preparedness Reauthorization Act’s specific statutory barrier to the direct funding of 

tribes. Principle Chief Lambert also asked why the act was written in a way that would exclude 

tribes. He encouraged the tribal nations at the meeting to be vocal with their congressional 

representatives, so that the act could be amended in 2018 to specify that tribes that meet 

applicable requirements can be funded directly. Mr. Smith concurred that, at this time, the agency 

can only strengthen and clarify the notice of funding opportunity language. This language cannot 

conflict with statutory language but it can define the parameters of funding enactment and 

establish performance measures and accountability checks. After that, the TAC had no further 

inquiries for Mr. Smith, so Vice President Jonathon Nez, TAC Vice Chairman and Navajo Area 

Delegate, closed the session and thanked Mr. Smith for participating.

Tribal Public Health Workforce in Surveillance and Epidemiological Data 

Captain Kristine Bisgard, DVM, MPH, supervisory epidemiologist with the Epidemic Intelligence 

Service (EIS) Program in the Center for Surveillance Epidemiology and Laboratory Services 

(CSELS), and Mr. Umed Ajani, Associate Director for Science in CSELS’s Division of Health 

Informatics and Surveillance, participated in the roundtable discussion session on Tribal Public 

Health Workforce in Surveillance and Epidemiological Data. The TAC provided the panelists

with the committee’s briefing document for CSELS. Vice President Nez advised the panelists to 

respond to the briefing document.

Captain Bisgard addressed the committee regarding the EIS program. She reported that while 

the program’s total numbers are down, there remains approximately seventy EIS officers.

Currently, the program has one EIS officer in Indian Country located at the Northwest Portland 

Area Health Board. Mr. Ajani responded to concerns about the Nationally Notifiable Disease 

Surveillance System, stating that while CSELS plays a critical role in collecting the clinical data, 

not all the data comes through that center. He explained that the process is complex and that 

case definition agreement is the first hurdle that must be overcome to coordinate a national 

system. When asked how CSELS ensures that the designation of AI/AN is properly documented, 

Mr. Ajani shared his understanding that there are jurisdictional reports that include this 

characteristic and that these reports are submitted within the jurisdiction and/or state. Vice 

President Nez shared with the CSELS representatives that many healthcare workers do not 

check the AI/AN box. In these cases, when the information goes to the state, it is never counted 

at the tribal level. Vice President Nez asked the panelists how to train facilities on the criticality 

of appropriately completing forms to identify AI/AN, especially at the associated Tribal level

when possible. Mr. Ajani stated that CSELS could work with other organizations to provide this 

training and affirmed that CSELS serves as the subject matter expert but the boots-on-theground assistance is required to improve the data quality. Mr. Ajani also shared that both the 

Council of State and Territorial Epidemiologists and the Association for Territorial and State 

Health Officials are partners of CSELS. CSELS can engage with these partners to identify 
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CDC/ATSDR Tribal Advisory Committee Meeting

February 14–15, 2017—Executive Summary

possible tools and strategies to address the data integrity concerns raised. Vice President Nez 

thanked the panelists and closed the session, opening the floor for tribal testimonies.

Tribal Testimonies Were Accepted

Closing Prayer/Adjournment

Vice President Nez reminded the agency of the letter submitted to Rear Admiral Schuchat that 

requested tribal consultation in the selection of CDC leaders under the new administration. He 

asked that responsibility for consultation remain with OSTLTS and TSU to ensure that the letter 

is championed with new agency leaders. He advised that TSU should use the TAC Strategic 

Priorities document from October to steer its work and should develop a tracking document 

with a routine reporting cycle. He urged CDC to continue to increase the investment in Tribal 

public health infrastructure and TSU and OSTLTS to continue work in this area. Vice President 

Nez then gave the closing prayer and adjourned the meeting.

Acronyms

AI/AN American Indian/Alaska Native 

ATSDR Agency for Toxic Substances and Disease Registry

CDC Centers for Disease Control and Prevention 

CSELS Centers for Surveillance Epidemiology and Laboratory 

Sciences

EIS Epidemic Intelligence Service

IHS Indian Health Service 

NCCDPHP National Center for Chronic Disease Prevention and Health 

Promotion

NCIPC National Center for Injury Prevention and Control

OD Office of the Director

OPHPR Office for Public Health Preparedness and Response

OSTLTS Office for State, Tribal, Local and Territorial Support

TAC Tribal Advisory Committee 

TBHA Tribal Behavioral Health Agenda

TEC Tribal Epidemiology Center 

TSU Tribal Support Unit